Provider Demographics
NPI:1013524925
Name:TITUS, RENEE CHERIE
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:CHERIE
Last Name:TITUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 SAINT JOHNS BLUFF RD S APT 901
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2605
Mailing Address - Country:US
Mailing Address - Phone:248-979-6638
Mailing Address - Fax:
Practice Address - Street 1:GROWING TOGETHER CENTER 6789 SOUTHPOINT PARKWAY
Practice Address - Street 2:BUILDING 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-379-6045
Practice Address - Fax:904-301-4741
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician